Angina pectoris is chest pain associated with injury of the heart muscle. This is due to a lack of sufficient oxygenated blood at a time when the heart has to meet with higher demands. Angina pain has a number of characteristics that can help to differentiate it from heart attack pain or heartburn. The latter, heartburn, is due to acid reflux and is frequently mistaken for angina. Symptoms are experienced by a person and is therefore subjective. Signs are clinical features that can be verified independently and often monitored accordingly.
Location of Angina Pain
The pain in angina pectoris is typically felt behind the breastbone (retrosternal) and sometimes may be more pronounced slightly to the left of the sternum. However, even pain on the right of the sternum can also be due due to angina. Typically the pain is described as a crushing or constricting pain. Patients may also describe the pain as burning or aching or even a tightness in the chest. Severe, sharp or stabbing pain is rarely due to angina – it is more likely due to conditions like pericarditis.
The pain tends to radiate to the arm and neck since the heart and these parts of the body develop from the same embryonic tissue. The more common presentation is for it to radiate to the left arm and left side of the neck. Sometimes it may also be reported to radiate to the epigastrium (the upper middle abdominal quadrant below the breastbone), jaw or back.
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Duration of Angina Pain
Angina pain develops gradually and can last for 2 to 10 minutes. The intensity of the pain is usually proportional to the level of exertion – strenuous exercise causes severe pain while moderate exercise may cause mild pain. In most cases the pain subsides within 5 minutes usually with rest. In variant angina or even unstable angina, the pain may subside for no known reason or even be triggered at rest.
Pain associated with a heart attack on the other hand tends to last for more than 10 minutes and does not respond to rest. While angina pain can subside completely in a short period of time, it may recur within minutes if the same precipitating factors are present.
Triggers of Angina Pain
More common :
- Physical exertion
- Emotional stress or shock
Less common :
- Eating a large meal
- Cold weather
- Rest – unstable angina
- Lying down flat – variant or unstable angina
Other Signs and Symptoms with Angina Pain
The concomitant signs and symptoms may help to differentiate between angina and a heart attack. Breathlessness is often present in both cases and other respiratory symptoms like a cough or wheeze may also be present. Sweating, paleness (pallor), nausea, vomiting and fainting is more frequently seen with a heart attack although it may occur in angina but is usually mild if present. Dizziness while present is severe angina is usually mild and never leads to fainting. Anxiety with an impending sense of doom is very prominent in a heart attack but is mild or absent in angina. However, the fear of a possible heart attack in angina often leads patients to become anxious and apprehensive about the pain.